Application Form for a Driving Licence D401
1. Have you previously held a learner permit and/or driving licence in Ireland?* Yes
If yes, which one? Learner Permit
Driver number* (if known)
(You will ﬁ nd this on Field 5 of the paper licence or Field 4d on a plastic card licence.)
2. Title Mr Mrs Miss Ms
Name to appear on the licence
3. First name(s)*
4. Surname *
As it appears on your birth certiﬁ cate
5. First name
6. If your surname has changed since your last licence issued please indicate the reason
Use of Irish name Divorce/Separation
7. Address 1*
8. Date of birth*
If aged 70 or over, a valid medical report will be required.
Day Month Year
9. Gender* Male Female
10. PPSN* Original proof of PPSN must also be provided. See page 4 of the Guidance Notes.
If born in Republic of Ireland, please state County. If born abroad, please state country
11. Place of birth*
12. Mobile no.
Part 1: Personal Details (See Part 1 of accompanying guidance notes) *Mandatory ﬁ eld
Application form for
a Driving Licence D401
Please read accompanying guidance notes before
completing this form. Please complete this form in
block capitals using a black ballpoint pen. Please place
an X in the appropriate boxes e.g.
Please do not
photocopy this form as it may reduce its quality and
result in your application being delayed or rejected.
Application Form for a Driving Licence D401 PDF
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